Chemical, Clinical, and Immunological Studies on the Products of Human Plasma Fractionation. Ix. The Treatment of Shock With Concentrated Human Serum Albumin: A Preliminary Report 12

Abstract

We have had the opportunity to treat 6 patients in shock with concentrated human serum albumin, prepared from pooled normal human plasma by the method of Cohn and co-workers (1).3 Five of these patients had circulatory failure from hemorrhage and the sixth from extensive burns. These observations were made at the beginning of our experience with the technics utilized in the study of shock by Cournand and co-workers (3). At this time, routine determinations of the cardiac output before and after therapy were not being made. METHODSThe arterial pressure was recorded from the femoral artery by the method of Hamilton (4). The mean pressure was computed from planimetric measurement of these tracings. The right auricle was catheterized by a method only slightly modified from that reported by Cournand and Ranges (5). Mixed venous blood was obtained from the right auricle and arterial blood from the femoral artery. The oxygen content of these specimens was determined by the method of Van Slyke (6 ' This study was carried out in order to provide more detailed information on the mechanism of the action of albumin in shock than was possible in the original clinical appraisal (2). use of the blue dye, T-1824, as described by Gregersen, Gibson, and Stead (7), and adapted to the Klett photoelectric colorimeter or the Beckman quartz spectrophotometer. Plasma protein concentration was determined by the specific gravity method of Barbour and Hamilton (8). RESULTSCase 1. A 45-year-old Negro was admitted to Grady Hospital because of stab wounds of the right forearm, forehead, and right flank. He had bled profusely, but there was no evidence of penetration into the peritoneal cavity. He had been drin,king whiskey and the blood alcohol concentration was 180 mgm. per cent. The tongue was pale, the radial pulse was weak, and the extremities were cool. There was no sweating. The veins of the forearm were visible and appeared full. The venous blood from the antecubital vein was dark. The systolic brachial blood pressure by the auscultatory method was 80 mm. of Hg, the diastolic, 60 mm. The pulse rate was 96 beats per minute. The observations recorded in Table I were made and at the end of this time the patient's condition seemed unchanged. Two hundred cc. of a 25 per cent solution of albumin were given in 50 minutes. Following this, further studies were made. During the period of time from the beginning of the auricular catheterization to the completion of the second cardiac output, the patient received 200 cc. of normal saline by way of the catheter. The patient improved steadily while the albumin was administered and had no untoward reaction. His hands became warmer, the volume of the pulse increased, and he was less restless. His convalescence was uneventful.Case 2. A 20-year-old Negress was admitted to the Grady Hospital soon after being stabbed in the posterior aspect of the right chest. The patient was slightly restless; the extremities were cool and somewhat moist.By auscultation, the arterial pressure was 80/60. Physical examina...

Blood Replacement

“…An average water retention capability of 17.4 ml per g albumin was determined. This figure was confirmed shortly afterwards by WARREN and his co-workers [1485]. Mild variations in the state of hydration did not affect these findings (dehydration 15 hours before to 20 hours after addition of the albumin compared with additional oral water and salt administration during the experiment).…”

“…WARREN et al [1485] have shown the effectivity of the albumin therapy by means of careful circulatory analysis. Blood pressure and cardiac output rise, and the arterio-venous oxygen difference decreases.…”

Chemical, Clinical, and Immunological Studies on the Products of Human Plasma Fractionation. Vii. Concentrated Human Serum Albumin 123

“…However, small amounts of albumin subsequently have been allocated to two groups of investigators, whose detailed studies of selected shock cases might contribute information of value to the armed forces. The results of these investigations are presented in subsequent papers in this series (7,8). The results in the original group of 200 cases have been previously reported (9).…”

“…Clinical evaluation The experimental evidence cited above seemed to confirm so well the anticipated theoretical advantages of concentrated albumin that a dinical program was instituted to determine whether the value of albumin could be proved in a series of actual cases of shock. To get a rapid, impartial evaluation, the cooperation of a number of clinics 8 was obtained, and their results were submitted to us for study. At the outset, it was felt that 1000 cases of shock of various types should be treated for the proper evaluation of this material.…”

Metabolic Changes Associated With the Administration of Salt-Poor Human Serum Albumin in Two Cases of Infectious Hepatitis 12

“…(Submitted for publication November 18, 1949; accepted, December 5,1949) Human serum albumin for therapeutic use was made available during the war and was used chiefly in the treatment of shock because of its high osmotic properties (1)(2)(3). Its use in kidney and liver disease as a nutrient material was also investigated (1,4,5).…”